Healthcare Provider Details

I. General information

NPI: 1063544062
Provider Name (Legal Business Name): STEPHANIE LEIGH BAER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREEDOM WAY # 235
AUGUSTA GA
30904-6258
US

IV. Provider business mailing address

1 FREEDOM WAY # 235
AUGUSTA GA
30904-6258
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax: 706-823-1713
Mailing address:
  • Phone: 706-733-0188
  • Fax: 706-823-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD.26343
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: